Case Study: The Harpers

March 19, 2018

Today I wanted to share a case study from one of my newer clients. This family agreed to share some information with me about their experiences so far. Their true names are being withheld to protect their privacy. I’ve decided to call them The Harpers.

The Harpers are a family of 3. Dad is 39, Mom is 36 and Kid is 11. Dad and Mom has recently celebrated their 12-year wedding anniversary. The whole family is generally healthy.

Over the last 5 years, Dad has been self employed. Mom works for a small company that doesn’t offer health insurance. So their only option was to buy a health insurance plan themselves. They researched Covered California. But they learned that their income is barely over the limit to get any help with their premium.

They enrolled into a modest plan. In 2016, they spoke with an agent that turned them on to the Blue Shield Trio plan. They switched to that plan and experienced some good premium savings.

When Open Enrollment came, they saw their premium jump up to $852.81 per month. The Harpers, who make a modest income of around $85k a year, were becoming frustrated, like a lot of Americans are. That’s when they started looking for new options. They called their agent again and asked for options. But the agent told them that they are already on the cheapest insurance they could have and keep their doctors. The information the agent gave them was not accurate, but it’s not the point of the story.

They were discussing their frustrations with the system with a family friend. This friend happened to be a health insurance client of mine. She suggested they gave me a call to see if there was anything I can do. They gave it a shot and called me.

The Consultation

Having going through their medical situation I learned they didn’t have any conditions. They also maintained a generally healthy lifestyle. I went through some options with them and recommended a HCSM that would cost them $591.20 per month. They were skeptical at first because it wasn’t the health insurance that they were used to. (It’s not insurance.) But they decided to give me the benefit of the doubt and gave it a try.

The (Unnecessary) Trial Run

They joined the HCSM, but they maintained their health insurance for the first month (December 2017.) Their thinking was they’d try it out before they plunged into it. I told them it wasn’t necessary, but they insisted. I was confident in the product, but I supported their decision.

They made an appointment in at the very beginning December. Their son who was complaining of an ear infection. They brought them to their family doctor. (The doctor was in network with their Blue Shield Trio plan as well as the HCSM.) They presented their HSCM ministry card as their new coverage.

The receptionist had never heard of it, but she did recognize the network’s logo on the member id. She gave the organization a call and learned about the HCSM and verified the kid’s membership. The Kid had his appointment and were charged the expected $20 for their consult fee.

During the appointment, The Kid was prescribed Amoxicillin to fight the infection. This is where The Harpers got nervous. They recalled during our consultation where I told them that the HCSM didn’t cover drugs. They also hear all over the news about how high the costs for prescription drugs can be. I did tell them the membership includes an embedded prescription discount program.

Despite that, they stayed true to their word and gave the HCSM a shot. They went to a local pharmacy as directed by the discount program, and turned in the prescription. When they picked it up, they shocked by the cost of the drug.

It cost them $3.68.

In all fairness, Amoxicillin is pretty cheap to begin with. But if they picked up this prescription with their standard health insurance, it would have cost them up to $45.

The Determination

The Harpers were pleasantly surprised about how well their membership worked. They informed me that they intended to stay with it and they were going to call Blue Shield to cancel. Their medical insurance cancelled effective 12/31/2017.

After they told me the story, I told them the better course would have been to call the telemedicine line first. They likely could have helped them over the phone and sent the Rx to the Pharmacy. They wouldn’t have even had to pay the $20 consult fee if they had done it that way.

After The Decision

Last month (February,) the Kid had broke his arm while playing with some friends at the park. The Harpers knew this would be the true test of their new coverage. They rushed him to an urgent care center. They were again charged a $20 consult fee upfront.

They preformed some x-rays, put a cast on his arm and sent him home with “something for the pain.” The son and parents decided not to fill the prescription as he seemed to be getting along fine without it.

As of the day of writing this – March 14th, 2018 – they received a bill for the urgent care. They opened it, expecting to see a high invoice. They were again shocked when their only out-of-pocket expense was another $25 for the read fee for the X-ray. The entire treatment cost them $45.

Conclusion

The Harpers are saving about $262 per month by enrolling into the HCSM I recommended for them. Their copays are lower than their medical insurance’s was. And they even managed to save money on the prescription by not using their insurance. I should express that this prescription savings isn’t typical, but it worked out in their situation. I normally see higher Rx costs, but it still results in better savings. (When you compare the amount you’re saving with the higher cost of the prescription over what a Rx copay would be.)

The Harpers still have inpatient and outpatient hospitalization, surgery and emergency room benefits as well. Even though they (thankfully) haven’t needed to use any of them, it’s there for them to have in case something happens.

When I asked Mrs. Harper what she was going to do with all the money she’s saving, she laughed. “Pay the bills?”

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About The Author

Jack

I started as an agent in 2018 after working over 15 years in the health insurance industry in nearly every facet imaginable - from Customer Service to Claims Adjudication to Underwriting. I'm now using all the knowledge I've gained to empower my clients to make the most informed health care plan choices possible.